The Dominican Mental Health System, Up Close and Personal

(They are coming to take me away, ho ho, ha ha, he he..)

Friday evening was quite an enlightening experience. I never thought I’d ever have to bump into the DR mental health system.

Unfortunately, I have had a LOT of personal exposure to the GA mental health system, public and private, with a younger sister diagnoses as manic-depressed and paranoid-schizophrenic as an early teen. It has not been fun and takes special people to work in that field.

Mom CB woke up Friday morning with such excruciating pain in a hip and leg she could not walk. We thought the dreaded Little Old Lady fractured hip or disintegrated hip socket could be at play even though no fall was involved. But at 91, who knows? Severe pain is severe pain.

We know the folks at bomberos and at 8:30 am they dispatched an “ambulance” right away with two “EMTs” to take her to HOMS, her choice in a facility. It was a 45-minute ride with Alida in the ambulance to translate. In fairness to the EMT’s, they went about their job very professionally, got her on a stretcher, down the stairs and in the ambulance with minimum pain.

We spent the next 12 hours in the freezing HOMS ER getting X-Rays, sonograms, anti-inflammatories and pain med infusions.

At around 9 pm we were told Mom CB could check out as soon as the completion of her last pain infusion.

Now I have spent a lot of time around major ER’s both personally and professionally. It’s not uncommon to hear some loud moaning, cries of angst or yelling for numerous reasons.

When I was just about to begin the check out procedure, I hear a man yell something in the ER lobby. We were in the far back of the ER, about 100’ from the glass security doors. He yelled again, and I detected both anger…and English. So, I went outside the curtain…with a bunch of other civilians in the ER with family…and saw the source of the noise: an angry black man pounding the reception desk repeatedly, swearing and screaming.

Yikes!

He continued ranting, swinging his arm all around and I caught a few words “nobody listens, leave me alone, I have to make a call, leave me alone, don’t touch me, I’ll kill you!” It was clear there was a significant issue with this guy.

I stuck my head into my Mom’s cubicle to let her know about the kerfuffle. When I looked out to the hall again, I saw a couple of guys…Security?...open the door and putting the guy into one of the hard-walled rooms. He was still yelling and screaming at the top of his lungs. He could not understand their Spanish, and none spoke English. Not a good combination in a serious confrontation with a clearly not-tightly-wound guy.

So I went to where hospital employees were standing outside the door, afraid of getting too close to this guy, and asked if I could help because I spoke English. These folks pretty much pushed me into the room.

What I saw: a nice-looking black guy, shaved bald, maybe 6’, at least 225, late 20’s/early 30’s, who has spent a LOT of time pushing steel in the gym. He reminded me somewhat of Evander Holyfield. This guy was built like a linebacker and in obviously great physical shape, very strong and muscular. It was clear why nobody wanted to mess with him. He wore a backpack, a grey T-shirt, jeans and sneakers. He was also trembling uncontrollably, and sweat was just pouring off his body, soaking his shirt and jeans, literally dripping onto the floor. He was sweating like an overweight lineman on the first morning of two-a-days ion FL.

My first reaction was “Bad drugs? Ecstasy? PCP?”

I said to him, “Hey, man, maybe I can help you.” He looked at me surprised a non-Dominican someone spoke to him in American English. “They keep messing with me, nobody listens…”

I said “I’m listening, what can I do? What's up? What's the problem? Talk to me.”

He said, “I’m suicidal, nobody listens, I need to make a phone call, I need a gun, [email protected]<k all this, I need to talk to them. I’ll kill these [email protected]<kers, they won’t leave me alone… I want to go to the public hospital. I came here to get a ride to the public hospital.”

Actually, he was well-spoken.

I asked, “Have you been drinking? Taken any drugs?”

"I drink a little before and after.” I never understood what that meant.

I asked, “You have a number? I’ll call.” “Yeah I have the number”, and he began repeating the digits. I told him I needed a pen and paper. I got it and wrote down the phone number that he knew by heart, a Suicide Crisis Hotline in San Diego. He’s sitting there trembling and sweating but calming down. I called…and got a recording “You’ve reached the blah blah blah Suicide Crisis Hotline. No one is here right now. If you are having a crisis call 911.” Well, that’s not gonna work. Besides: what suicide crisis hotline doesn’t have lines manned 24/7 during the holidays? Aren’t the holidays the most depressing time of year?

I told him to sit tight, I’ll go get some help. He nodded.

I went to the doctor’s station to see if they have any shrinks around. As I did, I heard a scuffle and the guy was back in the ER lobby, arms flailing but not hitting anyone. Still screaming, “I’ll mess you up!!! Leave me the [email protected]<k alone!!!” Then he went back into the ER and began throwing chair and tables all around, not at people, but at walls. He was totally losing it, and I was expecting to hear a gunshot at any moment. It was horrible.

He went back to the lobby, but now at least 10 HOMS Security guys were there and collectively they brought him down in a serious struggle, I counted eight in the take-down, and got handcuffs on him. It was no easy task. Ever hear about guys pumped on adrenaline picking up cars? That was like this guy.

So the guy is face down on the floor with his face in a puddle of sweat. He yells, “I want that American” (meaning me.)

I got on the floor and told him he needed to really calm down because if the police get there and he’s still angry it was NOT going to end well, they’d shoot him. He said, “OK, OK, I’ll calm down. Can you help me? I need help. I’m having a depression episode. I came here to get a ride to the public hospital.” I assumed he meant a mental hospital. I told him to chill, it was going to be OK, I’ll go see if it can happen, 911 to the hospital is a lot better than the PN taking him to jail.

The entire hospital staff and patients and family in the ER lobby were standing around, wide-eyed, not knowing what to do. I saw numerous cell phones out, so there may be video posted somewhere. The guy had 6 private security guys on top of him, pinning him to the floor, and they were obviously scared. The guy was, indeed, scary.

So I got a reception guy to call 911. Somebody else had called the police. I kept telling the guy help was on the way, stay calm. I got someone to get him some water. This guy was literally on a pool of sweat. But he had calmed down.

Meanwhile, Alida is calling relatives in medicine to get some help. One knew the head of psyche at HOMS, who called an English-speaking Orthopod at the hospital, who came to the ER. I explained what was going on and introduced him to the crazy guy, telling him I brought some serious help.

Then we found out a couple of things: 1) 911 was not going to come because he was crazy, 2) There was no mental hospital in Santiago and 3) the public hospital didn’t want him. So that left the NP…who had arrived but weren’t getting too involved…yet.

The doc asked me to see if he would promise to be calm if they sat him in a chair, and if he’d accept an injection to calm him down. He was very calm now, laying on the floor, and agreed. So I got the guys on top of him to remove their guns…I didn’t want the guy to go grabbing one, even handcuffed…and we got him up and sat him in a chair outside the ER. I sat next to him and chatted. He's from California. He had been in Santiago for two weeks. He had no hotel. He had no money. He had no airline ticket home. He came to the DR to get help for his depression (!!!! WTF???!!!). He was hanging with new “friends” who supposedly messed with him. At this point I got a vibe he may be ex-military by the way he used a respectful “sir” before and after every sentence, like “Sir, I have no money, Sir.”

I didn’t want to get too deep in talking with the guy.

The doc came out and wanted to speak with me. Seems he made some calls. He got the OK to pay whatever was necessary to get the guy to the public hospital. HOMS would pay the public hospital, a plane ticket home, and a visit by the local Embassy rep (the local asst. Consul?) because by agreement a foreigner who causes damage must be reported to the Embassy, although they would not report the damage as malicious or criminal (I did not know that. Any comments? Anybody have further insight?)

The guy let us have his backpack and told us where his passport was. He had no wallet, although he said he came to the country with one. There wasn’t much in the backpack, not even a change of clothes. An empty coke can. An energy drink. A toothbrush. Some receots from stores. I found all this very odd.

We got his passport and made a copy for hospital records.

We helped him back into the ER where the doc administered tranquilizer by IV. They were not going to remove the handcuffs until he was completely calm…with drugs. He had been calm before and then exploded. No mas. Heavy artillery this time.

Finally, I paid Mom CB’s bill (45-mile one-way ambulance trip, ER visit, X-rays, sonogram, and medications, total= US$215. Just wow.) and got her into the car. I went to check on my new friend and he was already gone, taken to the public hospital in a taxi with two security guys. I have no idea what his outcome is. I just assume the public hospital kept him zombied until he was out of the crisis zone, and somehow maybe the consul would get him back on an airplane out of the country, courtesy HOMS.

It was quite an evening. The acting Hospital administrator thanked me today, not sure why, I just talked to a fellow American having a real problem. It was the security guys who subdued him, and the doc who put the pieces together.

But the take-aways are this:

1) The Dominican Republic has *zero* public mental health crisis system in place, at least that is what the docs at HOMS said. There is nothing in place to mitigate a human in dire angst, no professionals, psych’s on call, inpatient facility, not even two guys in white jackets with butterfly nets. Nada. There are private institutions, but even they, beyond the astronomical expense, don’t seem to have a way to deal with crises in the field. I find this amazing. I don’t expect First World intervention, but not even a tranquilizer dart and padded cell somewhere? (I joke, of course.) So a guy like this flips out…and I doubt it’s the first time for him…and there is nothing that can be done short of police brutality?

2) As much as I respect HOMS, I am shocked a facility of that size and stature had no policies or procedures in place, not even a holding cell in the basement. One would think a prominent public/private healthcare facility would have some way to mitigate such an incident. They can do robotic and bariatric surgery, but nothing if a patient has a meltdown? Really? Did I think it strange that beyond subduing a man in the middle of a mental breakdown, they needed a patients’ family member to help resolve a tense situation?

3) Dominicans love a good train wreck, even if they refuse to sort through the carnage. While the “action” moved around the various parts of the ER, you’d have thought it was the walking gallery for Tiger Woods at The Masters. It’s a cultural thing.

eh. when we still had a pharmacy there was a couple of folks with mentally ill family members. many would be locked up in small outhouses, not much bigger than a dog cage. psychotic medicine was often used as last resort, when the "patient" became aggressive and unmanageable.

Kudos to you CB not only dealing with a serious family health issue but doing what you could in very difficult circumstances. I have dealt with many people in mental health crisis and who are also young and very strong. Talking and keeping them focused is a very difficult thing as well as dealing with violent outbursts. They are suffering and very scary individuals to deal with. They can cause severe harm to themselves and those trying to help them. I am sure those close to him would appreciate your assistance during this episode and I hope he gets the help he requires going forward.

Wow, what an amazing story .. Very eye opening ... I know some people hate Religion mixed in, but sometimes I think its Divine intervention.. You mom and you were there for a Reason,, to help this fellow American who imo would have bee possibly shot dead if not for your Translating and getting him under control in that situation.
Would be interested in knowing what happened to him after . Hopefully he made it back home ..

and a Suicide Hotline with no one there , and telling you to call 911 ? .... I'm thinking back here in the USA we may be LACKING a little as well. Obviously this man was counting on someone being there.

Kudos to you CB not only dealing with a serious family health issue but doing what you could in very difficult circumstances. I have dealt with many people in mental health crisis and who are also young and very strong. Talking and keeping them focused is a very difficult thing as well as dealing with violent outbursts. They are suffering and very scary individuals to deal with. They can cause severe harm to themselves and those trying to help them. I am sure those close to him would appreciate your assistance during this episode and I hope he gets the help he requires going forward.

Originally Posted by jd426

Wow, what an amazing story .. Very eye opening ... I know some people hate Religion mixed in, but sometimes I think its Divine intervention.. You mom and you were there for a Reason,, to help this fellow American who imo would have bee possibly shot dead if not for your Translating and getting him under control in that situation.
Would be interested in knowing what happened to him after . Hopefully he made it back home ..

and a Suicide Hotline with no one there , and telling you to call 911 ? .... I'm thinking back here in the USA we may be LACKING a little as well. Obviously this man was counting on someone being there.

I didn't want to get involved, really. My concern was for my mom and wife's safety.

But it was clear that language and culture were problems. Nobody spoke English and he couldn't speak Spanish so nothing was going to get better with no communications. And as far as I could determine, nobody in the ER could speak English, doctor, staff, patients or family, but me and Alida (Mom CB doesn't count.)

When I first went in the room with him I was clearly ready to react if something like his behavior went south. I have to admit to great concern speaking with him because my first impression was he on drugs. Just the fact I spoke English was a great comfort, because he didn't feel totally alone. I mainly wanted him to focus on me, and not lash out at all the others there, as he was 10' from a bunch of patients, many who were obviously really sick. I had a gut feeling that the guy was going to get shot by some hot-headed poorly-trained mall cop if things got a lot worse.

That, and I really felt sorry for the guy. I've seen similar violent outbursts numerous times from my sister. She couldn't help it, and I doubt he could either. That said I had no intention of physically restraining him if he went violent again while speaking with him. And talking with him was easier whan he was cuffed and on the ground. Even he knew it was over at that time.

I wouldn't wish the situation on anybody. I just hope HOMS thinks about future possibilities and puts some policies in place. But I doubt they will.

We've all seen the crazy guy on the street howling at the moon, and we just avoid him. But a large, muscular human going paranoid-schizo in an Emergency Room is a different situation altogether.

We have to go to HOMS tomorrow morning, and I'll ask around if anyone knows how it all ended.